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Der katheterbasierte Verschluss des linken Vorhofohrs

Schlaganfallprävention bei Vorhofflimmern

Catheter-based closure of the left atrial appendage

Stroke prevention in atrial fibrillation

  • Schwerpunkt: Interventionelle Therapien II
  • Published:
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Zusammenfassung

Beim nichtvalvulärem Vorhofflimmern sind >90 % der nachweisbaren kardialen Thromben im linken Vorhofohr („left atrial appendage“ [LAA]) lokalisiert. Insbesondere auf dieser Grundlage wurde in den letzten Jahren der katheterbasierte Verschluss des LAA als ein Verfahren zur Schlaganfallprävention bei Patienten mit nichtvalvulärem Vorhofflimmern entwickelt. Eine erste randomisierte Studie zum katheterbasierten LAA-Verschluss hat vielversprechende Ergebnisse im Hinblick auf die Effektivität und Sicherheit dieses Verfahrens im Vergleich zur oralen Antikoagulationstherapie mit Vitamin-K-Anatagonisten gezeigt. Dank der Weiterentwicklung der Implantationstechnik sowie der Devices hat die periprozedurale Sicherheit in den letzten Jahren in erfahrenen Zentren weiter zugenommen. In der klinischen Praxis wird der LAA-Verschluss aktuell insbesondere bei Patienten mit nichtvalvulärem Vorhofflimmern und relevantem ischämischem Risiko (CHA2DS2-VASc-Score ≥2) sowie hohem Blutungsrisiko durchgeführt, d. h. bei Patienten, bei denen die Durchführung einer dauerhaften Antikoagulationstherapie problematisch ist. Der Beitrag beschreibt die Entwicklung des Verfahrens, bisher vorliegende Erfahrungen aus randomisierten und Registerstudien, aktuelle Leitlinien und Expertenempfehlungen sowie den Einsatz in der klinischen Praxis.

Abstract

In patients with nonvalvular atrial fibrillation, >90 % of thrombi are detected in the left atrial appendage (LAA). In particular these observations have resulted in the development of catheter-based LAA closure as an approach for stroke prevention in patients with nonvalvular atrial fibrillation in recent years. A preliminary randomized trial provided promising data with respect to efficacy and safety of this approach as compared to anticoagulation with warfarin. The safety of the procedure has been significantly improved in recent years due to procedural experience and refinement of implanted devices. In current clinical practice, this approach is particularly used for patients with nonvalvular atrial fibrillation, a significant ischemic risk (CHA2DS2-VASc score ≥2), and a high bleeding risk, i. e., in patients in whom there are relevant concerns with respect to long-term anticoagulation. The present article discusses the data from randomized clinical studies and registries, the present guideline recommendations, and the practical clinical use of LAA closure for stroke prevention.

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Authors and Affiliations

  1. Klinik für Kardiologie, Charite – Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12003, Berlin, Deutschland

    C. Skurk, D. M. Leistner, J.-W. Park &  U. Landmesser

  2. Deutsches Zentrum für Herz-Kreislauf-Forschung (DZHK), Standort Berlin, Berlin, Deutschland

    C. Skurk, D. M. Leistner &  U. Landmesser

  3. Berlin Institute of Health (BIH), Berlin, Deutschland

    U. Landmesser

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  1. C. Skurk
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Correspondence to U. Landmesser.

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Interessenkonflikt

C. Skurk und D. M. Leistner geben an, dass kein Interessenkonflikt besteht. U. Landmesser hat Vortrags- und Advisory-Board-Honorare von St. Jude erhalten. Jai-Wun Park ist als Trainer/Ausbilder für die St. Jude Medical und Occlutech tätig.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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H. Haller, Hannover

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Skurk, C., Leistner, D.M., Park, JW. et al. Der katheterbasierte Verschluss des linken Vorhofohrs. Internist 57, 844–855 (2016). https://doi.org/10.1007/s00108-016-0113-z

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  • DOI: https://doi.org/10.1007/s00108-016-0113-z

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